Symptoms - Pain

Pain is one of the most common symptoms of lung cancer. In some people, it may be the first or only symptom. The chest and lower back are the most common places to feel pain from lung cancer. Cancer pain can increase emotional distress and lead to depression.^1-3

Talk to your doctor if you have pain that interferes with your day-to-day life. Record details about the pain to help your doctor understand. They can suggest treatments and monitor progress. If you are not getting the answers you need, ask for a referral to a pain specialist.⁴

What does pain look like for people with lung cancer?

There are 2 general types of pain:²

• Acute pain – limited duration usually caused by a definable injury or illness
• Chronic pain – longer duration with a gradual or poorly defined onset

Acute pain is often linked to increased heart rate, high blood pressure, sweating, and pale skin. For people with lung cancer, acute pain is most common in the chest and lower back. It may get worse with deep breathing, coughing, or laughing. About 20 percent of people with lung cancer have chest pain at the time of diagnosis.^2,5,6

More than half of people who have any kind of cancer live with chronic pain. As lung cancer advances, pain tends to get worse. People with later stages of lung cancer often have more severe pain.²

Cancer pain can cause serious emotional distress. Longer and worse pain are linked to a higher risk of depression. Untreated pain can lead to preventable hospital admissions and emergency room visits.²

Many people with lung cancer have breakthrough cancer pain. This refers to flares of pain while you are taking pain medicine. This type of unexpected pain can cause even worse distress.²

Why does lung cancer cause pain?

Pain is usually caused by a combination of factors. The tumor itself is the most common cause. Lung cancer can cause pain by:^2,4,5,7,8

• Spreading to bones or the chest wall
• Forming Pancoast tumors
• Making hormones that increase levels of calcium in the blood

A Pancoast tumor is a type of lung tumor in the upper part of the lungs. It can affect certain nerves and cause a group of symptoms called Horner syndrome. This syndrome can include eye and face symptoms, as well as severe shoulder pain.^5,6

Pain can also be caused by other factors. Surgery, radiation, chemotherapy, and other cancer treatments can cause pain. Other health conditions may also lead to pain.²

How is lung cancer pain treated?

Treating cancer pain is an example of palliative care. This type of care does not focus on curing or managing the lung cancer. Instead, it aims to ease your symptoms and improve your quality of life. Palliative care can involve treating pain and other physical symptoms, as well as emotional and mental symptoms.⁶

Treatment for cancer pain depends on many factors, including:²

• Previous treatments for pain
• Lung cancer severity and outlook
• Risk factors for pain
• Impact of function and quality of life
• Other health conditions
• Personal preference

Management of cancer pain often includes a combination of medicines, including:^2,4,7

• Nonsteroidal anti-inflammatory drugs (NSAIDs)
• Corticosteroids
• Opioids
• Certain antidepressants

Quitting smoking can also reduce pain. Smoking after diagnosis is linked to worse pain and other complications. Unfortunately, pain is also a risk factor for smoking relapse in people with cancer.⁹

Integrative therapies, such as physical therapy and massage, may also relieve pain. In some places, medical marijuana may be legal to treat cancer pain.⁴

If pain is caused by metastasis to the bone, your doctor may suggest radiation therapy to treat the cancer in the bone. Drugs called bisphosphonates may also be used to help prevent bone breakdown.⁷

Talking to your doctor

Unfortunately, cancer pain often goes undertreated. Some doctors may not ask about pain or know enough about pain treatment. Many doctors are hesitant to prescribe prescription pain medicine, such as opioids. This is because of concern about opioid abuse.^2,4

In other cases, people with lung cancer are hesitant to talk about their pain. They may worry that their cancer is worsening. Or they may worry about doctors seeing them as complainers. They may also fear the side effects, including opioid addiction.^2,4

However, the risk of opioid addiction in people with advanced cancer is low. You may develop a tolerance for pain medicine, and this could mean your doctor may need to prescribe a higher dose. But a tolerance is not the same thing as an addiction.⁴

A close working relationship with your doctor can help make sure you treat pain properly. You can also request a referral to palliative care or a pain specialist. Keep track of your pain in a journal to help your doctor understand. Record how it feels, where it happens, and what causes and relieves the pain. Rating your pain on a scale from 0 to 10 may help.⁴